Healthcare Provider Details

I. General information

NPI: 1427467398
Provider Name (Legal Business Name): ELIZABETH ESCOLASTICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PENN PLZ 946
NEW YORK NY
10122-0049
US

IV. Provider business mailing address

14 PENN PLZ 946
NEW YORK NY
10122-0049
US

V. Phone/Fax

Practice location:
  • Phone: 212-470-8554
  • Fax:
Mailing address:
  • Phone: 212-470-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number091872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: